Individual
JOHN JACOB SHANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
12009584
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000214282
BLUE CROSS BLUE SHIELD
—
01
—
190009098
RAILROAD MEDICARE
—
05
—
200169990A
—
IN
Enumeration date
07/17/2006
Last updated
01/27/2009
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